The pain a stiff neck brings about can be very bothersome and serve as a hindrance when it comes to carrying out the tasks that we need to do everyday. But what exactly causes this tightness in our necks?I was thinking about just general ways that I can give you a little bit of help with some aches and pains. As you know, I've tried to specialize in musculoskeletal, hence the name. We also look at what's going on with the connective tissue as well. Things about joints, the fascia, the nervous system and ways to actually make you feel like you are feeling stable.Today, I'm going to focus on the neck and give you some tips on how you can relieve a ropy and bandy scalene if you’re on your own or cannot come into the clinic to see someone like me.
Causes of Stiff Neck:
Looking down for a long period while reading, writing, or using your phone;
Excessive or vigorous movement of the neck;
Sleeping in the wrong position, which exerts too much pressure on the neck
Clenching the jaw;
High stress levels;
Medical conditions such as osteoarthritis and spinal disorders
Trauma to the neck or back due to injuries, a hunched posture, or picking heavy weights; and
Sudden movement of the head due to whiplash, which can pull your neck muscles and also can give rise to other serious symptoms.
Source: Vaughan, J. (2021)
Treatment:
Feel along the suboccipital ridge all the way along, both sides, to see if they feel even.
The area that feels painful, is not the area of complaint.
Gently tuck your chin down and feel around the back of the lower part of your skull (the top 3 survival muscles) and feel around the lateral joints.
Feel with two fingers and do some cross-fiber work .
Keep your shoulders down so you do not activate the trapezius muscles.
Once you find the tight ridge, palpate and see if you can feel into the area where the ribs are.
Feel for the upper trapezius and duck anteriorly to it, then press your fingers down into that tight space.
Palpate around the other side to see if it’s the same or different.
Drop your ear down to give a little bit of softness to the tissue of the lateral neck which will allow you to really sink deeper into the muscle.
Press and depress onto that region of the lower neck, it is the area that feels like it would be accessing your first rib, by doing this movement we are also making small changes to the restrictions or tightness over the second rib.
Laterally flex away from the area and give yourself a little active stretch while sinking down a little deeper.
As you work along your neck, press towards it and then gently glide away.
Repeat the process one more time this time moving a little more medially. Come closer to the neck dropping down and in.
Start to pull away and take the chin away, then try to access those fibers for posterior scalene, dropping down and back then coming along and forward.
Palpate and see if that made a difference. The scalene should be feeling less taught and bandy, and you should feel better through the range.
I want you to think about the things that make a difference to the neck. Sometimes we have to look at other distal attachments. We can apply joint play on our first and second ribs if they are stiff, palpate along the clavicle where the subclavius is and work on those fibres. Focusing also on the pectoralis major and minor to improve functional movement of the clavicle and shoulder joints. Assess one side versus the other to see if the problems felt in the neck can be compared to and aligned with the tightness felt in the chest tissues.Watching the video attached to this blog will assist you greatly in some self-treatment options whenever you feel restricted in the neck.References:Source: Vaughan, J. (2021) How to Get Rid of a Stiff Neck. eMediHealth. Retrieved from https://www.emedihealth.com/bones-joints/manage-stiff-neck#some_causes_of_a_stiff_neck
What are the adductor muscles how can we treat them?The adductor muscles are called adductor muscles because they add or adduct in. Anatomically, when we think of them, they are going to be attached to the pubic bone, and attach to either the femur or the pes anserine. The latter being our twolonger joint adductors.Our adductor muscles assist us when it comes to moving the leg inwards. When the leg moves toward the body, it uses the longer adductors as the primary movers, and when the knee is in flexion, it uses mostly the shorter ones including brevis, and etcetera.The adductor muscles play a huge role in hip stability and pelvic control. They need to be treated if we see pain or instability of the ilia, the knee, in general tightness with sitting wide legged or cross legged. Moreover, it is also an indication for treatment if there has been sporting injuries where the pubic bone or soft tissue of the hip, thigh or pelvis is present.
Treating the Adductor Muscles
If you are going to treat someone who has any of the symptoms listed above the best way to do so is by having them lay sideways.To begin, we should first asses the ability to list the affected leg in both straight and knee bent movements. Why do we do this? It is so we can get an understanding of whether the short or longer adductors (or both) need to be treated. In the video demonstration below we can see that there is more weakness and incorrect lifting when the knee is bent and the longer adductors removed from the assessment. This meant my focus of treatment would be closer to the upper leg (proximal) rather than if she was weak and felt pain with a straight knee.
Steps to Follow
Start to feel around the inner leg and gently palpate for muscle hypertonicity (muscle feels tight).
With some lotion or lubricant, place your hands at around a 45 degree angle towards the upper inner thigh and slowly glide along the tissue—starting from just above the knee, towards the pubic bone.
If you come across any taught bands, you can cross fiber across the belly of the muscle/s using a gentle action. There are loads of nerves housed along the inner thighs so this can be painful if too deep or too quickly frictioned.
We can also work into the muscle groups palpating for long bands of firm or tight muscles. These normally run along the line of the femur and not across it. To address these restrictions, let us apply a positional release technique. The bands can start anywhere above the knee and soften midway along the femur or in nasty restricted cases all the way up to the pubic attachments.
Now, making use of both your hands, place each thumb on the area where the tautness begins and push your thumbs towards each other. This is called the positional release technique, which is an excellent way to change the tension between two ends of the muscle fiber. We actually shorten the muscle belly by physically bunching it into the middle. Think about an uncooked sausage and if you apply pressure at each end and direct towards the middle, then that area has less tension.
Hold the positional release until you can feel a sensation at the tendons where it feels like it’s softening. For about 90 seconds or until you feel that the muscles start to give. It should feel slightly uncomfortable but not dreadful.
Start to feel around the inner leg once again, and gently palpate for any further restrictions of the muscle. If there is still some tightness, repeat the process.
The video below shows me treating Kristen’s adductor muscles. We can see that in the start of the video she is experiencing hip flexion as well as difficulty when lifting her lower leg. Then after completing all these steps, we can see that she is feeling less tenderness in her adductor muscles and can actually lift her leg more easily in a better range.Watch the full video instruction below:Sources:Hank Grebehttps://www.istockphoto.com/photo/male-hip-adductor-complex-muscles-anterior-view-isolated-on-human-skeleton-gm1271838675-374300620?utm_source=unsplash&utm_medium=affiliate&utm_campaign=srp_photos_top&utm_content=https%3A%2F%2Funsplash.com%2Fs%2Fphotos%2Fadductor-muscles&utm_term=adductor%20muscles%3A%3Asearch-aggressive-affiliates-v1%3AaAdductor Magnus. (2012). Physiopedia. https://www.physio pedia.com/Adductor_Magnus
Even before Covid, people have been prone to spending hours in front of a computer, either for work, school, or even just for entertainment. This is what we are going to fix here by doing some simple neck and shoulder exercises for office workers. And when we’re in front of computers, we tend to disregard our posture. Most people who sit in front of their computers all day tend to lean their necks forward. Long periods in this position are bound to give referral pain patterns. It is important to do short exercises that will get them into neck extension.Before we even begin with exercises, there is an important thing to consider. The chairs that you or your patients use must be of the right height for the legs and back. It must have back support and elbow rests. This is important because often, an uncomfortable chair can affect our posture when we sit, which is one of the leading causes of neck and shoulder pain.
Step-by-Step Guide for the Neck and Shoulder Office Exercise
In this article, I will share with you a few easy exercises to check your range. It is important to see how comfortable you are when you go into flexion, extension, and rotation. These exercises (neck and shoulder office exercises) will help determine whether you feel any restrictions in your movement whatsoever.
For the neck:
Sit up straight, slowly tilt your head forward, bringing your chin to the chest.
From this position, slowly tilt your head upward, until you are looking at the ceiling.
Return to the starting position, looking straight ahead.
Turn your head gently to the left, then to the right. Return to the starting position.
Lastly, slowly lower your head to your right shoulder. You should be able to do this at a 45-degree angle without any restrictions. The shoulders should not hitch up, and instead, remain still.
Return to the starting position, and repeat, slowly tilting towards the left shoulder.
Arm ranges to check with adductions, abductions, and flexions:
For the starting position, hold your arms out on both sides.
Raise both hands up overhead. Repeat 5 times. this is to check elevation.
Return to starting position. Then slowly swing your arms forward to check horizontal flexion. Repeat 5 times.
Return to starting position, then stretch them backward to check extension. Pull your shoulders back as far you can. Repeat 5 times.
Lastly, do figure of 8 movements.
For the elbows:
Hold out your arms in front of you, palms up.
Bend your elbows up towards you. Repeat this 5 times, then return to the starting position.
Twist your arms outward gently. This is to test internal and external rotation.
Lastly, try to do the figure of 8s movement with your elbows.
For the wrists and hands:
You will start with the same starting position as the one from elbows. Bend your wrists upward five times.
Then, move them from side to side.
Lastly, do figure of 8 movements.
Go back to starting position, then flip your hand over so that your palms are facing down.
Bend your fingers 5 times.
Then stretch them out, holding them apart from each other. Repeat this five times
Lastly, try making piano movements with your fingers.
Another tip for your neck and shoulder office exercises
After these neck and shoulder office exercises, make them go through the neck ranges again, to see if they get any changes. Another tip I have today is to tuck the chin back into your neck. I always use the analogy of pretending that someone you really don’t like is coming up to you and is trying to give you a great big kiss on the chin. Naturally, you would be recoiling your head back.
Tuck the chin in. This is the starting position.
Hold your arms out to your sides, and then pull your shoulders back, like step 4 for the arm movements. hold for 10 seconds.
Relax.
Repeat it 5 more times.
I recommend doing these 2 to 3 times every day, as doing so will give you a lot more flexibility as well as reduce the pain in your neck and shoulders. For a demonstration of the movements, please watch the video.
This is one of my 3 favourite muscle names in the body – it’s in your neck and it’s called the platysma!First of all, what is the platysma? It is a muscle that begins at the jawline, right at the mandible, and runs down in a fan shape to the superior portion of the clavicle. It is responsible for helping the mouth and lips to move. Specifically, it is the muscle that we use when we react with fear or fright – when our mouth is drawn down or to the side.
Many therapists miss out on getting the best outcomes because they overlook this little muscle. In fact, did you know that a lot of neck-related pain can be traced to the platysma? As therapists, 75% of people entering our clinic complain of either neck or lower back pain! If you are focusing your techniques at the back, which is quite often joint-related or soft tissue around the traps, splenius, etc, then can I ask you to try this simple technique on your next neck pain client?
I could go as far as to say unless we address the tightness in the platysma. We won't get full neck movement.
Your First Moves
First, you must assess your client’s neck range. From a relaxed, sitting position, have your client lookup or go into full neck extension. Watch and be vigilant on the lift to note any tightness of the anterior neck esp the flat band of the platysma. Have your clients return to neutral or as neutral as they can. This video will show you step by step how I teach the muscle and surrounding soft tissue via way of an active glide. This way both of you are working together. Plus, they are increasing their afferent and efferent nervous system. They will also increase their agonists and antagonists, and myofascial trains.
Active Glide
For therapists out there, when we do active movements, it means that both you and your client or patients are actually actively involved in the process.
1. Stand on the treating side, in this case, stand on the right and have the client turn their head to the right, as far as they can go comfortably.
2. Place two fingers or knuckles. If you have OA issues just above their right clavicle at the midline closest to the supraclavicular notch and sink into the tissues. The fingers will be facing out towards the AC joint on the superior line of the clavicle so that you can take up the tissue along with its attachments.
3. Have your client slowly rotate their head back towards the left as far as they can go comfortably.
4. As they move their head allow your fingers to glide along with their muscle. Work with a pace that mimics the speed of the rotation and at the tension of the hypertonic muscle/fascia.
5. I always apply any technique three times before I re-assess. NB* make sure you DO re-assess!
6. Repeat the same process on the other side.
The Results
As you’re doing this, it should feel “tight” and “stretchy” or “burny” to your clients – all signs of fascia, muscle, and/or tendon. Have your clients test their range again, by moving their heads up, down, and side to side. The results can be astronomical in pain management, posture, and range. You should be able to see the tissues are not as taut as this time around.
The beauty of this work is that you can offer it to clients as homecare. This is an attempt to release any ongoing restrictions felt in the neck. This is another cool technique that adds value along with the other ways to assist in neck pain that we've discussed in earlier videos.
Have fun and hope this helps you and your clients in the future!
Are you in a constant state of stress? With everything that has been happening in the world right now, I cannot blame you. Several things can trigger stress, such as sudden changes in your environment, feeling pressure, and anxiety. There is such a thing as ‘good’ stress, which can help us when trying to meet deadlines, or when our body acts on instinct when we are in danger. However, too much stress can be quite draining emotionally and physically. One physical aspect it triggers significantly is our breathing.
Breathing is usually an involuntary act, which means that your body does it even without conscious effort. This is important because our entire body needs oxygen to function properly. Proper breathing has multiple benefits such as mental clarity, better cognition, improved posture, helps the quality of our sleep and even aid in proper digestion.
But when our body is experiencing stress, it hinders our effective breathing. Everyone experiences stress occasionally, so when that happens, we will need to work on our conscious breathing. This requires the use of the cortex of the brain. Stimulating the motor cortex helps the brain stem to work with up and down regulators to improve things such as posture, pain regulation and overall oxygen efficiency.
Two Breathing Techniques
To help with that, I recommend using your diaphragm when breathing. This is also called belly breathing. I have two techniques for you to practice being able to get a feel for diaphragmatic breathing.
Lie face up, with your knees bent and your feet flat on the ground.
Place a book of your choice on your belly.
Breathe in deeply and visualize the muscles of your lower regions of your thorax activating whilst taking the air in through the nose.
Exhale through the mouth. Repeat this process at least ten times.
You should be able to see the book on your belly rise and down as you use your diaphragm to breathe. However, if you are still having trouble, I will share with you another technique which involves locking down your upper ribcage. Doing so will restrict the top end of the breathing cycle and will consequently work the lower end of the breathing cycle. To do this technique, you will begin as you did the with the first exercise, lying face up with the knees bent and feet flat on the ground.
From this position, take one hand and place it underneath your buttocks.
Then, take the opposite hand, reach across your chest and wrap it halfway down your upper arm.
Again mindfully taking each breathe in through your nose.
Exhale through the mouth. Repeat this exercise ten times.
Both techniques are truly helpful to stimulate oxygen throughout the body. I ask my patients to do this each morning when they wake up or whenever they are feeling stressed and have a place they can stop for 2 minutes. Firstly I make sure they have stimulated their neuro lymphatic points aka Chapmans Reflexes, you can literally do this anywhere at all.
For a better view of this exercise, have a look at this Youtube video.
We see lack of movement caused by so many different things now. The usual sedentary lifestyle from poor motivation, restrictions in where and how to get exercise AS WELL AS the increase in working from home. This has all amassed to increases in sitting, both on the computer and then in front of the television.
The outcome is restriction and stiffness in the full spine and specifically poor thoracic spine mobility.
We also need to consider those people who have recently experienced violent trauma as which includes motor vehicle accidents, bad falls, sporting injuries etc. These insults also induce pain and immobility on our thoracic vertebrae.
Other precursors to a stiff and painful thoracic spine include people suffering from Osteoporosis in jobs requiring strenuous lifting, patients with a history of cancer, drug abuse, HIV, or partial or complete suppression of the immune response/prolonged use of corticosteroids. These are just a few of those I see in my clinic complaining of “a bad upper back”.
Muscles Involved
The muscles involved in Thoracic Rotations are:
“During rotation, the external oblique (EO), rectus abdominis (RA) and lumbar multifidus (MF) muscles act contralaterally, whereas the latissimus dorsi (LD), internal oblique (IO), and transversus abdominis (TrA) muscle act ipsilaterally3,4,5,6). Trunk rotation is a motion involving both thoracic and lumbar vertebrae.1”
Some of the most commonly known treatments for pain in the thoracic region include stretching, massage, and some other counter (OTC) medicines. Others, also try heat and/or cold therapy which helps lessen the muscle pain and stiffness in the short term but have little evidence around the long-term benefits.
So what can YOU do to help if you have a stiff, painful back? If you struggle to get up in the morning, find it difficult to twist to look over your shoulder when driving or simply turning in seated or standing positions.
Here is a quick exercise you can do just about anywhere to help relieve this tension and limited thoracic rotations. Stretch twists of the torso can help improve rib mobility, muscle restrictions, and ultimately diaphragm integrity which is probably the biggest benefit when we consider the need for blood enriched with oxygen.
I want to offer you the feeling of length/balance of the spinal segments, feeling taller or straighter, and the overall state of postural strength of the core. This is also a very good practice to strengthen your Diaphragm & Upper Torso.
In the first sequence, put one hand underneath your leg locking your sit bones securely onto the table or chair, while your other hand is across your body and grabbing the chair to be able to start you on your way to twisting your spine.
Twist as far as you can go and then try to return to the midline using the muscles of your trunk but use that second hand to hold on and resist.
Hold that position for about 10 seconds and return back to the centre position so your back is in neutral.
Take a deep cleansing breath in/out and then relax.
In the second sequence, repeat the twist to as far as you can turn the spine. Then include a head/neck turn in the same direction to apply a small amount of overpressure to the stretch.
Hold this position for 10 seconds, return to centre and take another full breath in and out.
The third and the most important of the three sequences are including ocular or eye movement. This encourages the motor cortex to add more rotation via the descending pathways and usually assists in further changes in the nervous system along with the muscles and fascia.
Rotate both the head and body as far as possible and hold again for 10 seconds.
Now, make your eyes look as far around as you can possibly can and add a bit more stretch.
Watch this 2-minute video for a more visual presentation of this Twisting Exercise.
How long do you sit in front of your monitor every day?
Whether you're in a work-from-home or office setup, we can't deny the fact that sitting for a long time is a struggle for us. And I know how hard it is to find a comfortable position for your hips, butts, and legs. Here’s a DIY for your clients during Lockdown - the Myofascial Release and Stretching Technique for ITB Region and Adductors.Can’t access your regular massage therapist or can't afford one? No problem. Grab a tennis ball and get a cheap foam roller (simply bind two pool noodles together) and let's hit that trigger point one more time!
Myofascial Release
We talked about Myofascial Release in my previous blog, but for those who are new, let me describe it for you. Also called the trigger point release or active release technique. Myofascial Release is a technique used for treating skeletal muscle immobility. It involves applying continuous slow and deep pressure to the network of muscle/s that are stiff, restricted, or showing referral pain patterns.
Self-Myofascial Release
The fitness industry, businesses, and experts have embraced this technique because it's effective. Moreover, aside from being effective, this technique is easy-to-do and accessible.Why? Because you will do it yourself. And yes, we will be using trigger balls and foam rollers for that. Who would have thought of that, right?But first, let's know what trigger points that we will be hitting.
Iliotibial Band Track Region
The Iliotibial band tract (ITB) is also sometimes known as Maissiat's band. ITB Region is a dense group of fibers that extends from the outside of your hips and knees to the tip of your shin. The ITB serves as an important structure involved in lower extremity stability and in some instances motion.
Hip Adductors
In addition to ITB, we will be targeting your hip adductors as well. The adductors are a group of muscles that function to adduct the femur at the hip joint. Most of them are thin muscles. This group of muscles assists the equilibrium and coordination in your inner thighs.
Let's Begin! Below are the step-by-step procedures that you should follow:
Trigger Ball for Gluteal Muscles:
On your yoga mat or soft flooring, lie sideways. Make sure you are in a comfortable position. See to it that you are taking most of your weight on your elbows rather than having the ball leaving bruises on your buttocks.
Place the trigger ball onto the belly of your buttock muscle and locate the points that are probably exquisitely tender. Focus on the parts that cause a referral pain. When you feel that there is a referring pain down to your legs, that's when you know that you are in the right spot.
Inhale and exhale slowly and deeply and wait for the tightness in the muscle to start to soften off. You will feel like you are starting to have the tennis ball sink deeper into your buttock muscle.
Repeat the process until you feel that the pain is relieving bit-by-bit. You can find up to 4 or 5 areas that may be tender.
Foam Rollers for lateral thighs/ITB:
In the same sideways positions, find your lateral thigh right in the ITB Region and vastus lateralis.
Do the same thing, Slide the roller up and down. Apply an amount of pressure that equals your own pain scale. I usually suggest 7/10 as a maximum because we want to be firm enough to relax and loosen the area but not too hard as to create unwanted inflammatory responses.
Run the full length of those muscles and band until you feel like you are releasing some tensions on your lateral thighs.
Stretching Techniques for Adductors and Lower Back:
Since your inner thighs affect your lower back, let's do some stretching of the adductors and lateral trunk. Start by sitting on the ground and widening your legs till you feel a good stretch along the inner thigh.
Reach your arm overhead and then out to the side of the trunk to reach down to the ankle or lower limb. You will feel the right arm glide down the left leg and vice versa. This will improve cross patterning stretches and locking the “sit bones” down to keep the pelvis stabilized.
Hold each side-bend for a minimum of 10 seconds.
Go as downward as possible. In that way, we open up the hip and the pelvis.
Repeat 3 times on both sides.
These are the few techniques that you can use to treat yourself without the help of anyone. If you have aches and pains and want some easy to watch advice, then flick over and subscribe to my YouTube channel.Stay happy and safe folks! 😉
How can you shoulder a burden if the burden is your shoulder?
Admit it, your shoulders were designed to make every action possible, they adduct, abduct, flex, extend both vertically and horizontally and circumduct which means they can perform tasks as simple as lifting a pen through to carrying loads that can be as much as your weight or even greater. However, despite their versatility, shoulders are not well designed and are prone to injuries when overworked. And that explains the hassle of being unproductive when experiencing mild to intolerable shoulder pain. In today's article, we are to learn the Best Pain-Free Subscapularis Massage for Shoulder Pain.Whatever kind of pain it is, many therapists elect to focus on massaging the region of the complaint without looking further into the mechanisms of the shoulder. Massaging the local region is an effective solution if we are working towards increasing our mild inflammatory response when we work on the tissues, the general increase of fresh blood to your muscle and oxygen-rich nutrients purportedly assisting in tissue health BUT, a deep tissue massage could worsen the situation. The American Massage Therapy Association defines the shoulder as the interlocking of bones, cartilage, tendons, and fluid. It comprises muscles including the upper trapezius and levator scapula above, the rhomboids and lower trapezius medially, and the latissimus dorsi posterior and laterally. It also contains the rotator cuff which includes supra and infraspinatus, teres major and minor, and the subscapularis which is the largest and strongest muscle of the four rotator cuff muscles. A tricky muscle to access but necessary if you want good outcomes.Despite that, not a lot of people do work on the subscapularis when treating shoulder pain and when they do, it is painful and uncomfortable. In this article let me unravel a way for you to treat the pain without pain.
Here is how to apply the Best Pain-Free Subscapularis Massage for Shoulder Pain:
Standing - Check the range of internal rotation (medial rotation).
We should always get a benchmark of ROM when treating. It is for the patient as well as us to understand the before and after of treatment.FABRE for internal and external mobility is a great way to start. By this I mean to have them bend their elbow at a 90-degree angle, swing it inward reaching behind the back, and touch the inferior aspect of the opposite scapula. By doing this, you and your client can get an understanding of the quality and amount of mobility through the range, how stiff the shoulder is, where they feel the pain and or restrictions, and post-treatment, you can get a comparison and more ideas on what extra work needs doing or what exercise prescription is required.
Supine - Lay down on a table.
A massage table is perfect but NOT completely necessary. If you don’t have one you can look for a flat surface that is comfortable i.e., the carpeted floor or a mat, or even a very firm mattress. They need to be able to relax their shoulders. Laying down will also make it easier for you to locate the muscles to work on.
Exercise/treatment - Do low-load muscle activations.
What is low load muscle activation???If I ask you to perform a task such as raise your arm, you will recruit many muscles to perform that action. If I ONLY want ONE muscle to work then I need to get you to perform the EXACT movement that this muscle is required to do BEFORE the synergists turn on to assist in the action.So a low load action is one that is very small and very gentle. It required the therapist to know what the action of the muscle is and to have the client in the exact position for that muscle to fire first.https://www.yourmusculoskeletalspecialist.com/chapmans-reflexes-virtual-workshopsOur subscapularis performs two movement patterns for long and short-range so we need to improve the firing sequence of the muscle at these two ranges for effective treatment gains. When the action or strength of contraction of the muscle returns, so too does the resting length improve. This means the stronger the muscle the longer it sits at rest. When it is at a better resting length there is far less compression into the joint capsule and therefore less work for the other muscles working in the rotator cuff.Before we start this best pain-free Subscapularis Massage for shoulder pain, let’s consider draping and privacy issues. Both males and females should have appropriate covers for the breast tissue (wear appropriate crop tops) before you do the low-load muscle activation. If your client has lower back pain, put a pillow or bolster under the knees to keep the back flat.
Start in short-range as it’s easier for the shoulder if there are signs of impingement through end range.
As the therapist slide your fingers along the rib line and drop in behind the anterior part of the scapula and until you can palpate the muscles of subscapularis.Pop your fingers down to that area and link in so that you can feel the movement when the patient is doing a contraction.For Short Range
The subscapularis is going to adduct the arm, so the elbow comes in towards the body at the same time as the forearm medially rotates. This is a very gentle contraction for a few seconds only and then FULLY relax and repeat for approximately 20 repetitions. You will start to feel your palpating fingers sliding and gliding down between the spaces of the ribs and under the scapula as the muscle starts to soften and lengthen.
For Long-Range
Do an isometric contraction. Take your client's arm into their overhead end range and hold it there, have them perform the similar to “spiking” a volleyball. That is returning the straight arm down to their side by using the armpit muscles to perform the action. The subscapularis is now drawing the arm forward and down. Repeat the “up, down, relax” contraction until you see that the arm is starting to go further into extension without impingement.
Stand and repeat to see the results.
Do the FABRE or Apley’s scratch position again to measure your range of internal rotation once done and compare it with the previous one.As you can see, treating shoulder pain doesn’t need to be as painful as you believed. This is really one of the simplest ways to apply a treatment for improving a weakened or damaged muscle for the client and removes the pain and fear response attached to the treatment.
Don't forget to watch this Best Pain-Free Subscapularis Massage for Shoulder Pain video
CLICK ON THE VIDEO (Best Pain-Free Subscapularis Massage for Shoulder Pain) for the best way to see them in action and remember what I’ve taught you, take note of these processes so that you’ll never worry about painfully treating the shoulder. If you want to know more, visit my YouTube channel where I teach you how to do treat related concerns.
This is a shoulder injury and neurolymphatic point stimulation case study. A 44-year-old healthy female came to me presenting a 5 ½ months-post fall that caused a fracture to her greater tubercle and dislocated the humerus posteriorly.
Intervention and Outcomes Before using Chapmans Reflexes
A variety of interventions were performed by her physiotherapist before commencing treatment with me and the application of Chapmans reflexes.Non-surgical relocation of the humerus was performed by her surgeon followed up with weekly rehabilitation therapy with physiotherapy using closed chain small exercises. To date, she has a humeral elevation close to 80 degrees. She was also seeing her regular chiropractor, Dr. Sandy [10 years +]. She has included acupuncture to try for more movement in the shoulder complex. Dr. Sandy referred her to me to address the still limited range of motion.
Interventions using Chapmans Reflexes and Various NMT
For the interventions using Chapmans reflexes, one treatment was applied per week for three weeks. Then one more 14 days later with follow-up in so that she could return to full ROM and strength. This also enables her to perform push-ups from a toe stance. The pain was significantly reduced to VAS less than 1/10. I also addressed her underlying chronic lower back pain complaint.
METHODS
INITIAL PRESENTATION
Mrs. W showed:
tension/hypertonicity
tight left lateral neck and shoulder
some altered sensation
numbness over the region of the lateral humerus. Her description of the region included "feels like a block" and
"has a heaviness when trying to reach overhead".
Over the last 10 weeks, she stated that the medial and anterior deltoid muscle "now finally getting the tone and feels like it is activating". She had actively been doing her home care as instructed by the physiotherapist assigned to her. The home care included the use of heat packs to alleviate the tight and tense soft tissue.
Assessment
Her levels of stress were reported were extremely high. She stated that she felt like she was holding everything internally. She was unable to take full diaphragmatic breaths and her thoracic range of movement was limited in all ranges.Strength testing was performed and showed moderate weakness on the diaphragm-supraspinatus isometric test. There is also a moderate weakness to the latissimus dorsi, the thoracic extensors, posterior deltoid/shoulder complex, and the external humeral rotators.
Treatments
Treatments for Mrs. W included the following:
Chapmans Reflexes – Commenced by stimulation of the neurolymphatic points feeding the diaphragm and then teaching her diaphragmatic breathing to elicit the “relaxation response” and trigger the parasympathetic nervous system. Chapmans Reflexes were applied to the neurolymphatic points for the latissimus dorsi anterior and posterior points and the Tx and shoulder extensors, where I followed the protocol of vigorous but not deep rubbing for 30 seconds in each region. Once these areas were stimulated her strength had improved to very strong isometric holds of the shoulder muscles and increased ROM of humeral extension and internal adduction.
Muscle Energy Technique - Following the neurolymphatic stimulation, I added a muscle energy technique to the humeral internal rotators. This will allow greater resting length in these muscles and increase mobility and ROM of humeral external rotation. During the post isometric relaxation phase, the resting length of the muscle will be greater. This technique has been found to effectively reduce capsular restrictions noted at the glenohumeral joint through ROM.
Low load muscle activation - She then performed a low load muscle activation of the subscapularis in its closed position. The action of the subscapularis is internal humeral rotation as well as adduction of the humerus. This allows the target muscle to contract independently from the other muscles used in the action of the primary muscle.
Neuromuscular techniques - Various neuromuscular techniques including glides and gentle cross fiber movements to the biceps, pec minor, posterior deltoid, and the fascial line between the triceps in supine were applied. Seated active movements of the head and neck in rotation to the left upper and mid trapezius and thoracic erector spinae, prone to the left latissimus dorsi, around the scapula, rotator cuff, and levator scapula were also applied. Mobilization of the bilateral Cx joints to address the left-sided stiffness. Both sides were painful but became less painful after 3 applications on each side.
Homecare - This included activating the neurolymphatic points of the diaphragm, 10 diaphragmatic breathing, and breathing full breaths often through the day.
Mrs. W had plenty of resentment issues over the fall and the lack of support with those around her during the incident. So, we also discussed ways for her to do self-anger management and let anger become less of an impediment to her treatment progress.
2ND TREATMENT
Mrs. W did her homework using the breathing exercises to manage her stress and chest restrictions. She also wrote her resentment issues down on butcher paper and stated that she was “feeling like moving forward a bit more”. Her shoulder’s range had improved but still with pain and some mild swelling for a few days post-treatment. She attempted to do toe push-ups (did 3 this morning) which she had been unable to do.
Assessment
There were still some weaknesses with thoracic and humeral extensors and latissimus dorsi. Also, there was still weakness in recruiting the neck muscles to assist in the strength testing with a note to actively retracting the jaw in every movement. Strength testing also included weakness in neck flexion so the neurolymphatic point for the region was included. Assessment of supine rotations of the lower limbs to assess the balance of the soft tissues of the trunk lateral flexors, obliques, and deep lumbar rotatores, multifidi, and intertraversii muscles were done. Looking at the Anatomy trains and links to the functional backline, lateral line and spiral line with the connections from the shoulder and pelvis have led me to include lumbar muscle energy techniques to address rotations or torsions of the sacrum and/or ilia.
Treatments
Chapmans Reflexes - These were applied to the left latissimus dorsi, thoracic flexors/humeral extensors, and sternocleidomastoid/deep neck flexors. Re-assessment of strength was markedly improved with almost complete full range of shoulder abduction.
Local cross-fiber friction and neuromuscular techniques - These were applied to the upper anterior humerus/anterior deltoid tendon, subclavius, 2nd/3rd ribs at the sternalis region - using forced inspiration and expiration; myofascial ringing of my hands across the lateral humerus/ interosseous membrane just inferior to the deltoids with active humeral rotation, compression/stripping into the thenar muscle. These techniques were chosen to include the fascial arm lines of the Anatomy Trains. Studies show that restrictions along these superficial and/or deep arm lines will alter the biomechanical efficiency of the shoulder complex and cervical ROM. Lumbar muscle energy technique and gluteal stretches were included in this treatment. [Shoulder Injury & Neurolymphatic Point Stimulation - A Case Study]
Homecare – A 30-second stimulation of the neurolymphatic points of the latissimus dorsi, thoracic flexors/humeral extensors, deep neck flexors/SCM, and diaphragm were prescribed including 2 minutes of diaphragmatic breathing. I started Mrs. W on the functional stabilizing activity of wall springing push-ups x 20 daily. This reduces the load of the shoulder complex and still offers eccentric and concentric contractions to any of the muscles with attachments to the scapula, humerus, or ribs.
3RD TREATMENT
Mrs. W had been doing the Chapmans activations each day. She has full pain free range of the humerus in all ranges, has been doing wall springing push-ups and today performed 15 toes push-ups for her physician. He has commented that her post-non-surgical relocation recovery has accelerated far greater than usual progressions. He is very happy with her outcomes.
Assessment
The latissimus attachment pain is finally settled and latissimus strength is 100%. Shoulder ROM was considered to be full range in all planes, though a painful taut band was noted on the left teres major. We are now focusing on an ongoing episodic complaint of lower back pain which is 6-7/10 on the VAS scale and can flare up with long hours standing at work. Strength testing showed the weakness of the left lateral sling including lateral trunk flexors, gluteus medius/minimus; weak right gluteus maximus, right hip flexor iliopsoas, right superficial front and back fascial lines with weakness in strength testing of the quadriceps, gastrocnemius, and tibialis anterior.
Treatments
Neurolymphatic points stimulation - This was applied to the weakened muscles tested listed above. Neurolymphatic points relevant to musculoskeletal dysfunction are found primarily on the anterior of the body, when there is chronic weakness/stress we also need to treat the associated posterior Chapmans Reflex points housed near the erector spinae of the relevant spinal nerves.
Low load activation - I added low load muscle activation to the left rhomboid to increase the stability of the left rotator cuff of the scapula which affects the spiral line of the anatomy trains.
Prone various neuromuscular techniques - These techniques were applied to the gluteus maximus, minimus, and medius, adding compressive mobilizing techniques to the sacral ILA, sacrotuberous and iliolumbar ligaments, complimenting with myofascial release/passive internal rotations of the deep hip rotators, also applied XFF to the tendon of the right quadriceps in supine with Mrs. W adding active femoral rotations.
Homecare – Mrs. W continued to apply her 30 seconds of vigorous but not hard rubbing to the neurolymphatic points associated with the latissimus dorsi, thoracic flexors/humeral extensors, deep neck flexors/SCM, diaphragm and continue her diaphragmatic breathing each morning and if she felt she was going into a stress state. She will also include the low load muscle activation of the rhomboid muscle to address any dysfunction of the spiral line of the anatomy train.
4TH TREATMENT
Mrs. W booked in 2 weeks later – she had increased her University assignment load and she works full time as a registered nurse which added more stress to the shoulder and back. One episode of neuralgia from the right side of the neck resulted in a silent migraine occurred with excessive hours in front of the computer. Her shoulders were still maintaining full range of motion but last week, a feeling like a band or pressure developed across the posterior deltoid and over the shoulder which is still present today. No complaints of lower back pain since the last treatment.
Assessment
Full strength when testing the shoulder muscles which was encouraging. There was also a full range of movement though a feeling of the band over the deltoid still present. The taut band and pain commonly referred to as a "Trigger Point" was no longer present on palpation of the teres major. Lumbar rotations in supine were equal and full range. Sacral hypertonicity and painful areas were no longer a concern.
Treatments
Local neuromuscular treatment - This was applied to the left shoulder commencing with positional release techniques to the external rotators of the humerus, glides to the pectoralis minor and major.
Prone neuromuscular techniques - These techniques were also applied to the full-back, latissimus dorsi, lumbosacral and thoracolumbar fascia, shoulder rotator cuff, upper trapezius, and levator scapulae.
Homecare - Activation of the Chapmans Reflexes three times a week and increase to daily if the range reduced in any of the humeral movements were advised. She would continue with the low load muscle activation of the rhomboid before stronger shoulder exercises. She would have to find strategies to add small breaks into the assignment writing tasks so that long hours working at the computer are broken up.
LAST TREATMENT
Two weeks further to follow up and all ranges are full, pain-free, and feel easy throughout the entire range. I added a bike exercise to help with stress management. She would continue with the low load muscle activation and Chapmans Reflexes point stimulation.
Treatments
Therapeutic management - She asked to have a more relaxed treatment so I removed any neurolymphatic point stimulation or exercises to the treatment protocol and gave a general treatment including glides, effleurage, petrissage, myofascial release techniques, positional release techniques, some active and passive stretches.
Homecare - She would continue with the physiotherapist's exercise routine adding the low load and neurolymphatic point stimulation before these rehabilitation activities.
I followed up 6 and 12 months later and Mrs. W had no further need to intervene on her shoulder.
